How to Get Insurance to Pay for Doula Support: A Step-by-Step Guide

Hiring a doula can be an invaluable part of your birthing experience by offering emotional support, physical comfort, and informational guidance. Those who have had a doula supported birth and/or postpartum will tell you how much they loved having a trusted and dedicated support person throughout their experience, however, many people are unsure if they can afford to hire a doula.

If you are considering hiring a doula, the first thing you need to do is check to see if your insurance will cover the associated costs. It is important to note that you should expect to pay out-of-pocket for the full price of doula services up-front when hiring your doula, then you will submit the receipt of your paid invoice and insurance claim form for reimbursement from your insurance company. Some insurance companies will cover all doula costs, while others will cover some of the associated costs.

Here’s a comprehensive guide on how to navigate the insurance landscape to potentially get your doula fees reimbursed.

1. Understand Your Insurance Policy

Before anything else, take a close look at your health insurance policy. Check for the following:

• Maternity Coverage: Confirm that your policy includes maternity benefits.

• Out-of-Network Providers: Many doulas may not be in-network. Understand how your plan handles out-of-network services.

• Reimbursement Policies: Look for any mention of coverage for alternative birth support services.

• If you have Medicaid, be sure to check and see if your state is one of the few who will help pay for support from a state-verified community doula. (Virginia does!)

2. Research Doulas and Their Credentials

Not all doulas are the same. Some may have certifications or affiliations with professional organizations, which can make it easier to negotiate with insurance. Look for doulas who are:

• Certified by recognized organizations that align with your values and beliefs.

• Willing to provide documentation and codes that your insurance may require.

3. Ask Your Doula for a Superbill

Once you hire a doula, request a superbill—a detailed receipt that includes the following information:

• Your doula’s name, contact information, and qualifications

• The dates of service

• The services provided

• The cost of the services

Having a superbill is crucial when it comes to submitting a claim to your insurance provider. Expenses related to a doula, whose main focus is on labor and delivery support, are eligible for reimbursement. However, charges for postpartum doula services, where the primary focus is on childcare, are not covered. At Born Motherhood LLC, our postpartum doulas never provide childcare services; instead, they offer newborn/infant care education, breastfeeding support, maternal wellbeing support, and more. It is important to include an explanation of the primary purpose of doula care when submitting a claim. Parents should contact their insurance company's benefits department to obtain a clear understanding, preferably in writing, of the coverage and reimbursement policies for doula services.

When interviewing a doula before hiring her, make sure she has an NPI (National Provider Identification) number. This number is necessary for you to be able to submit an invoice/claim for reimbursement through your medical insurance provider.

Including doula services in your online baby registry is a great way to cover the initial out-of-pocket expenses associated with hiring a doula. Check out Be Her Village to build an online baby registry that will include a section for birth & postpartum doula support, educational classes, and breastfeeding support.

Don't forget that if you have an HSA, HRA, or FSA card, you can also use it to cover these out-of-pocket costs if possible.

4. Contact Your Insurance Company

Before submitting any claims, call your insurance provider. Here are some key questions to ask:

• Does your policy cover doula services?

• What documentation is needed for reimbursement?

• Is prior authorization required?

• What is the process for submitting a claim?

Make notes of the information you receive, including names and direct contact numbers for follow-up.

5. Submit a Claim

When you have all the necessary information, it’s time to submit your claim. Here’s how:

• Complete the Claim Form: Many insurers have specific forms for claims. Fill this out thoroughly.

• Attach the Superbill: Include your doula’s superbill with your claim form.

• Include Additional Documentation: If needed, attach any other documentation that supports your claim, such as referral letters or a letter of medical necessity.

6. Follow Up

After submitting your claim, keep an eye on the timeline. Insurance companies can take several weeks to process claims. If you haven’t received a response within a month, follow up:

• Call the claims department to check on the status of your claim.

• Have your claim number and any relevant details handy.

7. Appeal If Necessary

If your claim is denied, don’t lose hope. Insurance companies often deny claims the first time around. Here’s how to appeal:

• Request an Explanation: Find out why your claim was denied.

• Gather Supporting Evidence: Collect any additional information that might support your case.

• Write an Appeal Letter: Clearly state your reasons for appealing, citing relevant policy details and attaching all supporting documents.

8. Stay Organized

Throughout the process, keep detailed records of all communications with your insurance company, including names, dates, and summaries of conversations. This documentation can be invaluable if you need to escalate your appeal.

Conclusion

While navigating insurance can feel daunting, understanding the steps to get doula coverage can make a significant difference in your birthing experience. With persistence and the right information, you may be able to reduce your out-of-pocket costs significantly. Remember, your doula is a partner in this journey—lean on them for support, and don’t hesitate to ask questions. Good luck!